Abstract
BackgroundHealth institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency.MethodsA retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005.ResultsThere were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31).ConclusionAt the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution.
Highlights
Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health
This observation is supported by the finding of a population-based study on maternal mortality in North-Central Nigeria, which showed a much higher maternal mortality ratio (MMR) compared to hospital-based studies previously conducted in the same region [12]
It should be noted that the absolute number of maternal death is a self-evident measure that gives a clear indication of the public health impact of maternal mortality [13] and irrespective of the size of the denominator used for estimating our MMR, a total of 75 maternal deaths in such a short period is unacceptably high by any standard
Summary
Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. One of the key Millennium Development Goals (MDG), which the United Nations Member States pledged to meet by 2015, is improvement in maternal health by reduction in the MMR to one-quarter of the 1990 data [1]. In spite of the large number of maternal deaths, national statistics in most parts of subSaharan Africa are either not available or unreliable. This problem is partly attributable to the limitations of the methods for population-based measurement of maternal mortality, which cannot be readily overcome by low resource countries due to numerous socio-economic, infrastructural and cultural barriers [2,3]. Local enquiries into maternal deaths over a given period can be used to monitor as well as indicate measures for improving the quality of obstetric care provided in a health facility [5]
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